Archive for March, 2010

Personal Injury Coverage


To learn more about personal injury coverage, read the following article. It’s going to give you good insight. Personal Injury Protection (“PIP”) is a coverage option you can purchase on an auto insurance policy. It pays for medical expenses, lost wages, loss of household services and funeral expenses following an accident, regardless of who is at fault.

Depending on your auto policy type and the state you live in, minimum PIP coverage typically pays up to $10,000 in “reasonable and necessary” medical bills; $10,000 in lost wages, which is paid at amount of up $200 per week after the first fourteen days following the accident; $2000 in funeral expenses: and $5000 for loss of services, which is subject to a maximum of $40 per day and $200 per week.

Loss of household services would be such items as housekeeping or yard maintenance. In the event you are injured and unable to perform such tasks, your insurance company may reimburse you for these expenses up to the amount of the specified PIP limit.

Liability coverage is mandatory in 48 of the 50 states. PIP is not mandatory coverage but an important for of coverage nonetheless. It is a great benefit if you are injured in an accident. PIP will cover you regardless of who is at fault for the accident. Following an accident, you may be faced with significant medical expenses and unable to work. PIP can help cover these expenses.

While your health insurance, if insured, may be able to cover treatment caused by a motor vehicle accident, it does not cover all treatment. It may have limitations on coverage or not cover chiropractic or massage treatment.

Following an accident, PIP insurance is the primary form of insurance for medical coverage. Your health insurer would likely make you provide proof of no PIP coverage. They would only pay medical expenses in the absence of coverage. Once the PIP coverage has been exhausted, health insurance would pay for additional medical expenses per the terms of the policy.

Because PIP is such an important type of coverage, some states require you to waive PIP coverage in writing. Auto insurance companies are required to keep a copy of your signed waiver and may have to pay PIP benefits in the absence of a signed waiver form denying coverage.

You also typically have the option of purchasing higher limits of PIP coverage from your auto insurance company. For example, in Washington State, the higher optional level of PIP coverage pays up to $35,000 in medical bills; $35,000 in lost wages, paid at amount of up $700 per week after the first fourteen days following the accident; $2000 in funeral expenses: and $14,600 for loss of services, which is subject to a maximum of $40 per day.

PIP coverage may also apply in bicycle or pedestrian accident claims. A bicyclist or pedestrian injured by a vehicle is typically covered under the PIP provision of the driver’s insurance policy, regardless of fault. If the driver that strikes a pedestrian or bicyclist does not have insurance or is underinsured, the injured person may be able to use their PIP coverage or their parents’ PIP coverage to help pay for damages such as medical bills and lost wages following an accident.

Children can also be covered under their parents PIP policy. Depending on the state they live in, if for example, a child who was walking or on a bicycle was struck by a driver that did not have PIP, they may be able to use their parent’s PIP coverage.

Some auto insurance companies also offer med-pay coverage, which is different than PIP. This is more limited coverage and covers medical bills only up to specified amount, typically $5,000 and no other losses.

There is much to learn about insurance coverage and how to get the best rates. Learn more about PIP and the best car insurance companies at http://www.bestcarinsurancecompanies.net.

Article Source: http://EzineArticles.com/?expert=Jason_F._Nelson

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Personal Injury Hotline


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Healthcare providers across the country are now being targeted for healthcare fraud investigations. Many of those providers are clueless. They don’t even know why they’re being investigated.

Are Your Actions Causing You to Become a Target for a Healthcare Fraud Investigation?

Do you engage in one or more of the following:

- Accept what the insurance carrier offers, without question
- Work with 3rd- party liability carriers and accept what your patients give you once they receive settlement, and accept your patient’s account of settlement negotiations
- Allow your patients to retain an attorney to handle 3rd-party liability claims, and you accept the attorney’s offer of settlement without question
- Work consistently with a limited number of external providers (physicians, surgeons, neurologists)
- Fail to read the Explanations of Benefits (“EOBs”) in which the insurance carrier identifies the reasons for denial.
- Consider peer reviewers’ reports as nuisances and as costs of doing business with insurance carriers.
- Not bother to read, or don’t receive, Controverting Affidavits in which both reasons for denial are reported and aberrant practices are alleged.
- Fail to respond to Controverting Affidavits in which reasons for denial are reported.
- Fail to respond to Controverting Affidavits in which aberrant practices (unbundling of services, medically unnecessary services, medically unnecessary referrals) are alleged, because you either consider such allegations harmless or you have neither the time nor ability to provide a response challenging such allegations.

If the answer is yes, then you need to consider a healthcare compliance program!

While you can rationalize to yourself that these issues are just the cost of doing business, a nuisance and can be ignored, the consequences can be disastrous.

How to Save Your Practice, License, and Freedom If You Have Become the Target of a Healthcare Fraud Investigation?

I’ve spent decades in practice, and worked closely with insurance carriers, defense attorneys, personal injury attorneys, law enforcement, and others, I understand your fears and concerns. More importantly, I know how to help you gain the knowledge you need to identify the insurance carriers’ weaknesses and practice in an ethical manner.

I have seen the exodus of hordes of providers due the insurance industry’s stranglehold on the healthcare industry, and I have taught many providers to fight back. When investigators come knocking on your office-door, will you be prepared?

Here’s how you can prepare yourself now:

- Develop a healthcare compliance program. Do not make the mistake of believing that a sham compliance program will suffice. You are better off having no compliance program than merely using one for window-dressing. The false sense-of-security often proves disastrous!
- Create an audit-response program that effectively addresses deficiencies, both noted and alleged.
- Establish a policy for refunds of monies paid in error, when such errors are noted during internal audits.
- Develop an effective auditing process, assessing medical necessity and billing issues.
- Meet with SIU agents who may have “flagged” your files to identify specific areas of concern.
- Develop a Hotline to address issues of concern coming from employees, patients, insurance adjusters, etc.
- Attempt to enter into a Corporate Integrity Agreement between the targeted-provider and investigators.
- Retain a compliance team knowledgeable in healthcare law. Do not trust your fate to an attorney inexperienced in this arena. Rest assured, the insurance carriers will not!

What Are Your Next Steps?

Invest in a reputable health care compliance program now. Properly implemented and managed, a Healthcare Compliance Program could make the difference between losing your practice, losing millions of dollars, losing your freedom, and being in a position to proudly announce to healthcare fraud investigators, “Come on in. I would be proud to show you our program.”

Sham programs create more problems for you than you even want to contemplate. When you become the target of a health care fraud investigation, you do not want to be forced to justify why an unqualified compliance “guru” is helping you in this process.

Chiropractor and attorney, Dr. Tom Rhudy teaches thousands of healthcare providers and administrators how to keep their practice watertight when it comes to healthcare compliance rules, laws and regulations. Now you can get his FREE 106-page SPECIAL HEALTHCARE COMPLIANCE GUIDE created to minimize healthcare fraud and abuse at http://www.complianceinformationnetwork.com/

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Personal Injury Witness Statement


A so called “personal injury Witness Statement” is an imprtant factor when it comes to how the specific case turns out in the court of law. The burden of proof in personal injury cases lies with the plaintiff. It is for the plaintiff to prove before the court that the defendant caused the victim’s injuries and not the other way round. The defendant does not need to prove that he/she was not in any way responsible. Rather, the defendant would try to prevent the plaintiff from proving the same.

Personal injury cases being a type of civil lawsuit, the plaintiff has the responsibility of proving their case by prevalence of evidence. Now, how do you prove a case by a preponderance of the evidence? There are no standard parameters in a personal injury case with which one can prove the defendant caused the victim’s injuries. It is the evidence and testimonies presented by the plaintiff in the case shall prove that the defendant most likely violated the law. If such proof is accepted by the court than the plaintiff shall be able to recover damages by way of compensation. The types of evidence used to prove the culpability of the defendant are physical and photographic evidence as well as witness and expert testimony.

During he course of the trial the focus should be on how the evidence meets the burden of proof for the plaintiff. This requires sound legal knowledge, skill and practice, which would be extremely difficult to do without the services of a personal injury lawyer. A competent personal injury lawyer understands the admissibility of the available evidence, knows how to present the evidence in a convincing manner and can argue that the evidence proves beyond doubt the fault of the defendant. Therefore, it is incumbent upon the plaintiff to consult a personal injury lawyer to improve the chances of being compensated for the injuries suffered.

A successful personal injury claims case should reflect the three integral elements of breach of duty care, causation and liability for damages. The courts consider breach of duty care by individuals to be negligent. But this negligence must be shown to have caused directly or partially the damages claimed in the case, which is known as causation. To prove negligence requires substantiating the reasonable duty of care in a particular situation, but also demonstrating that the defendant did not meet the standard of care. In any court such factors are used as evidence in personal injury claims cases.

To handle such legal principles and burden of proof in each claims case that are unique, specific to an occurrence and also complex in nature, requires a competent injury lawyer to file and pursue a successful claims lawsuit. Apart from that, an experienced personal injury lawyer knows how to carefully build your case, negotiate with the insurance company and if necessary, take your case to the court. More often than not, insurance companies try every trick to take advantage of you to effect the lowest possible settlement. They also make attempts to elicit information and statements that are damaging to your interests. But with a personal injury lawyer you are safe and in good position to obtain a favorable settlement.

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